Challenge in Diagnosis and Management of a Patient With Myocardial Bridge and Coronary Artery Spasm

Positive ischemia by noninvasive imaging studies often results in nonobstructive disease in cardiac catheterization. In this case, we observed ischemia by nuclear stress test in only the anteroseptal area, and the apex is free of ischemia. Coronary angiogram findings were unremarkable, but intravasc...

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Bibliographic Details
Published inJACC. Case reports Vol. 20; p. 101950
Main Authors Ha, Edward T., Qu, Yongxia S., Takahashi, Tatsunori, Parikh, Manish A., Kobayashi, Yuhei
Format Journal Article
LanguageEnglish
Published Elsevier Inc 16.08.2023
Elsevier
Subjects
ANOCA
Case Report
coronary artery spasm
myocardial bridge
ANOCA
myocardial bridge
CAS
MB
coronary artery spasm
LAD
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Summary:Positive ischemia by noninvasive imaging studies often results in nonobstructive disease in cardiac catheterization. In this case, we observed ischemia by nuclear stress test in only the anteroseptal area, and the apex is free of ischemia. Coronary angiogram findings were unremarkable, but intravascular ultrasound confirmed the long length of the myocardial bridge. Further testing with spasm provocation and microvascular testing showed diffuse epicardial spasm in this area of myocardial bridge without microvascular dysfunction. We observed the myocardial bridge but no microvascular dysfunction. This case illustrates the coexistence of spasm in the area of a myocardial bridge and the challenges in the medical management of these patients. (Level of Difficulty: Advanced.) [Display omitted]
ISSN:2666-0849
2666-0849
DOI:10.1016/j.jaccas.2023.101950